What do Patients Think When They Think of Cannabis Clinical Trials?

After the change in the legal status of medical cannabis earlier this year, Australia is now intending to run clinical trials to evaluate its efficacy for a range of applications. However, the success of these trials could be hindered by a lack of patient adherence. We know from previous research with other medications that several factors can impact adherence levels, from prior knowledge about the drug to specific preferences in the mode of administration and perceptions of efficacy and of its side effects.

These aspects are quite pertinent to medical cannabis trials. Surveys of patients who already consume cannabis for medical purposes show that smoking is by large the preferred route of delivery. This modality, however, cannot be adopted in healthcare spaces due to current legislation and the potential risks of respiratory toxicity. Concerns about adverse effects, but also more general attitudes towards cannabis — a substance that has had very negative labels — could dissuade certain patients (while also attracting those with unrealistic expectations).

To gather information on these issues, a team of Australian researchers led by Dr. Tim Luckett conducted a survey on the preferences, attitudes, and beliefs of cancer patients willing to consider participation in future cannabis clinical trials focusing exclusively on appetite-related symptoms. The surveys were administered to two hundred adult patients and the findings were published in the Internal Medicine Journal.

Thirteen percent of the patients surveyed had used cannabis for medical ends before, mostly for pain and appetite loss management, but also to address psychological problems, insomnia, and nausea. The most common route of delivery was smoking, followed by oral ingestion (capsules, mouth spray, or in food and drinks), and vaporizer. Most of these patients would be okay with stopping their current use to enroll in a trial.

When asked about any preferences for administration route, most indicated capsules or tablets (71%). Mouth sprays and vaporizers were preferred by 40% of the patients, followed by drinks and food. Topical creams and suppositories were the least preferred (26% and 8% respectively). The most common justifications for these preferences were perceived ease of administration, and familiarity. Some patients reported concerns related to taste, lack of appetite, and nausea. Fewer patients mentioned perceived differences in efficacy and speed of action, adverse effects, or enjoyment. Several patients were reticent with certain forms due to not wishing to take any more tablets, or difficulties in swallowing, inhaling or using suppositories. Seven percent of the patients mentioned smoking preferences (in a “joint” or “glass pipe”) when asked about other forms not listed in the survey.